Predictors of Left Ventricular Reverse Remodeling in HFrEF Patients Treated with ARNI Combined with Standard Heart Failure Therapy

Haiyan CHEN; Wei CHEN; Wei ZHAO

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Haiyan CHEN, Wei CHEN, Wei ZHAO. Predictors of Left Ventricular Reverse Remodeling in HFrEF Patients Treated with ARNI Combined with Standard Heart Failure Therapy[J]. Journal of Kunming Medical University.

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Haiyan CHEN, Wei CHEN, Wei ZHAO. Predictors of Left Ventricular Reverse Remodeling in HFrEF Patients Treated with ARNI Combined with Standard Heart Failure Therapy[J]. Journal of Kunming Medical University.

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Predictors of Left Ventricular Reverse Remodeling in HFrEF Patients Treated with ARNI Combined with Standard Heart Failure Therapy

Department of Medical Imaging，The First Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032，China

Received Date: 2025-06-03
Available Online: 2026-04-26

Abstract

Abstract

Objective To analyze, based on cardiac magnetic resonance imaging （CMR）, the factors influencing the occurrence of left ventricular reverse remodeling （LVRR） in patients with heart failure with reduced ejection fraction （HFrEF） following treatment with an angiotensin receptor-neuropeptide inhibitor （ARNI） combined with standard anti-heart failure medications. Methods This study enrolled 65 patients with HFrEF who were treated at the First Affiliated Hospital of Kunming Medical University. All of whom received treatment with ARNI combined with standard anti-heart failure medications. Clinical data, medication history, and CMR and echocardiographic parameters were collected. Patients were divided into an LVRR group and a non-LVRR group based on echocardiographic follow-up results, and statistical analysis was performed. Results The median follow-up duration was 10 （5, 20） months. The LVRR group comprised 31 patients （48%）, and the non-LVRR group comprised 34 patients （52%）. Compared with the non-LVRR group, the LVRR group had a higher initial ARNI dose, a lower incidence of atrial fibrillation, and higher values for interventricular septal thickness, left ventricular lateral wall thickness, myocardial mass, and myocardial mass index. Additionally, the LVRR group had a smaller left atrial anteroposterior diameter （LAAPD） and a lower percentage of late gadolinium enhancement （LGE） myocardium relative to total left ventricular myocardial mass （LGE%）. All these differences were statistically significant （P < 0.05）. Regression analysis of these variables with LVRR as the endpoint identified three predictors of LVRR: ARNI starting dose （OR: 3.253, 95%CI: 1.277～8.285, P = 0.013）, LGE% （OR: 0.789, 95%CI: 0.647～0.963, P = 0.020）, LAAPD （OR: 0.883, 95%CI: 0.804～0.969, P = 0.009）. Conclusion ARNI starting dose, LGE%, and LAAPD are predictors of LVRR in patients with HFrEF treated with ARNI combined with standard heart failure medications. CMR can provide prognostic indicators for ARNI therapy in heart failure.

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References(24)

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